tbuckley/cabot-search huggingface dataset:
Abstract 9226: Stroke in Bicuspid Aortic Valve
Authors: Geoffrey D Huntley, Hector I Michelena, Jeremy J Thaden, ADHAM K ALKURASHI, Sorin Pislaru, Alberto Pochettino, Juan A Crestanello, Joseph J Maleszewski, Robert D Brown, Vuyisile T Nkomo
Journal: Circulation (2022)

Background: The bicuspid aortic valve (BAV) exhibits abnormal geometry and transvalvular flow and is susceptible to calcification with subsequent cardioembolic stroke from calcific embolic material. However, the description of embolic ischemic strokes in patients with BAV is limited to case reports. Methods: Consecutive patients from 1975-2015 with BAV (n=5401) at our institution were retrospectively identified. Patients with ischemic stroke before aortic valve replacement (AVR) were analyzed, and the stroke was characterized. Patients were grouped according to stroke etiology: calcific embolism from a BAV (BAV stroke); large artery atherosclerotic or lacunar stroke (LA stroke); and non-BAV, non-large artery embolic stroke (nLA stroke). Results: There were 83/5401 (1.5%) patients with ischemic stroke. Mean age was 54 ± 12 years and 28% were female. Stroke etiology was BAV stroke in 26/83 (31%), LA stroke in 23/83 (28%), nLA stroke in 30/83 (36%), and other in 4/83 (5%). Stroke was embolic in 72/83 (87%), as shown in Figure 1. CHA 2 DS 2 -VASc score was not different in patients with BAV stroke (1.4 ± 1.2) versus nLA stroke (1.8 ± 1.2, p=0.188) but was higher in LA stroke (2.3 ± 1.2, p=0.005 vs. BAV stroke). Recurrent stroke occurred in 41% overall (50% BAV stroke vs. 30% LA stroke vs. 47% nLA stroke, both p=NS vs. BAV stroke). BAV stroke was more commonly located in the retinal circulation (39% BAV stroke vs. 13% LA stroke [p=0.044] vs. 0% nLA stroke [p=0.002]). Patients with BAV and LA stroke were more likely to have moderate-to-severe aortic stenosis and undergo AVR sooner after stroke compared to patients with nLA stroke. Conclusions: Stroke is an important complication in patients with BAV. The most common type of stroke in BAV is embolic. Greater than one-third of embolic stroke resulted from embolism from a calcific aortic valve. Patients with BAV stroke commonly have a history of recurrent cerebral ischemic events, severe valvular disease, and proceed to AVR soon after stroke.
Abstract 9312: Factors That Predict the Choice of Oral Anticoagulants in Men and Women With Atrial Fibrillation
Authors: Laurie-Anne Boivin Proulx, Aurélie Langlet, Catherine Legault, Marc Dorais, Sylvie Perreault
Journal: Circulation (2022)

Introduction: Potential sex-specific differences in oral anticoagulation (OAC) initiation among atrial fibrillation (AF) patients discharged from hospital into the community have not previously been investigated. This study identified sex-specific factors associated with OAC initiation in patients with AF. Methods: Using hospitalization and drug databases, we built a cohort of AF patients having been hospitalized and then discharged to the community between 2014 and 2017 in Québec, Canada. The primary outcome was the choice of OAC (warfarin, high-dose or low-dose DOAC) initiated upon hospital discharge, based on the first claim at the index date. Multivariate logistic regression was used to identify predictors of low-dose and standard-dose DOAC vs warfarin initiation, and low-dose vs standard-dose DOACs initiation. Results: 32,050 patients were included, from whom 16,896 (53%) were women. In both sexes, warfarin initiation decreased while DOACs initiation increased over time. 17.3%, 29.0% and 53.7% of women were started on warfarin, low-dose and standard-dose DOACs, respectively while 15.6%, 16.6% and 67.8% of men were started on warfarin, low-dose and standard-dose DOACs, respectively. Year of initiation was a predictor of DOACs (odds ratios (ORs): from 1.40 to 8.37) (vs warfarin initiation in both sex (Table 1). Older age predicted the use of low-dose DOACs vs warfarin in both sex (ORs: from 1.65 to 3.99 age 65-79 and from 1.83 to 10.29 in age ≥80), while a CHA 2 DS 2 -VASc score ≥3 predicted the use of low-dose DOACs in women only (ORs from 1.98 to 2.49). Age ≥80 (ORs: from 17.99 to 64.82) and chronic kidney disease (CKD) (ORs from 2.82 to 7.42) predicted the use of low-dose DOACs vs standard DOACs in both sex (ORs: from 2.64 to 3.29 age. Conclusions: Women were more likely than men to received low-dose DOACs and the decision to initiate low- vs standard-dose DOACs was mainly driven by age, CKD status (in both sexes) and a high CHA 2 DS 2 -VASc score (in women only).
Abstract 9804: Diabetes Mellitus and Acute Heart Failure With Reduced Ejection Fraction: A National Database Study
Authors: Maria Khalil, Eduardo Gomez-Pineiro, Tanveer Mir, Mohammed Uddin, Amir Khalil, Hamza Tahir, Nihat Uddin, Rifah Tasniya, Waqas Qureshi, Mujeeb sheikh
Journal: Circulation (2022)

Background: Literature regarding outcomes of acute heart failure with reduced ejection fraction (HFrEF) in patients with diabetes mellitus (DM) is still evolving. Objective: To study the all-cause mortality and clinical outcomes of acute HFrEF in diabetic patients. Methods: Data from the National Emergency Department Sample (NEDS), which constitutes 20% of the sample of hospital-owned emergency departments (ED) in the United States (US), was analyzed for hospital encounters related to acute HF and DM using International Classification of Diseases-10 (ICD-10) codes. Results: Out of the total 1,479,716 acute HF encounters (mean age 69.7±14.9 years,47.3%females) recorded for the years 2016-2018, 803,308 (54.3%) were acute HFrEF-related, with 317,517 (39.5%) HFrEF with DM. The HFrEF with DM group had higher multi-organ complications including NSTEMI (14.6% vs 12.9%; p-value &lt;0.001), acute kidney injury (AKI) (29.3% vs 26.2%; p-value &lt;0.001), AKI requiring hemodialysis (10.5% vs 6.7%; p-value &lt;0.001) when compared to HFrEF group only. However, the all-cause mortality for HFrEF only was higher as compared to HFrEF with DM (5% vs 4.8%; p &lt;0.001). Moreover, HFrEF with DM group had higher coronary interventions including PCI (7.6% vs 7.1%; p-value &lt;0.001), and CABG (1.9% vs 1.4%; p-value &lt;0.001). Conclusion: Surprisingly, HFrEF complicated by DM did not show significant worsening in mortality rates compared to patients with acute HFrEF. Ischemic cardiac work-up showed mortality benefits. The possibility of selection bias for ischemic cardiac procedures suggest more randomized trials to evaluate the hypothesis generated. Keywords: Acute heart failure with reduced ejection fraction (HFpEF), diabetes mellitus (DM), all-cause mortality, Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG).
Abstract 9444: Differences in Hospital Outcomes Following Watchman's Procedure Based on CHA <sub>2</sub> DS <sub>2</sub> VASc Score: Insight From National Inpatient Sample Database, 2016-2019
Authors: Biraj Shrestha, Bidhya Poudel, Anthony Donato
Journal: Circulation (2022)

Background: Uncertainty exists whether a higher CHA 2 DS 2 VASc risk score is associated with poorer in-hospital outcomes than a lower risk score following Left Atrial Appendage Occlusion (LAAO) procedures. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with primary atrial fibrillation or flutter from 2016 to 2019 with codes for percutaneous left atrial appendage occlusion device placement. Cohorts with high (CHA 2 DS 2 VASc ≥5) and low (CHA 2 DS 2 VASc &lt;5) risk of stroke were compared. Weighted multivariable logistic regression was used to assess the association between CHA 2 DS 2 VASc score and in-hospital outcomes. Results: Out of 60,350 procedures performed, 50.61% had high CHA 2 DS 2 VASc score ( &gt; 5) and 49.39% had low score (&lt; 5) (table 1). All patients received the Watchman device. The primary outcome of in-hospital mortality was not statistically different between high and low risk (0.18% vs. 0.12%, OR: 1.53, 95% CI: 0.59-3.96, p=0.37), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 1.44, 95% CI: 0.55-3.62, p=0.46). In the high-risk group, total complication rates were similar (adjusted OR: 1.16, 95% CI: 0.97-1.38, p=0.09) as was ischemic stroke (adjusted OR: 2.05, 95% CI: 0.82-5.13, p=0.13) while systemic embolism (adjusted OR: 5.09, 95% CI: 1.08-23.99, p=0.04) and major bleeding requiring transfusion (adjusted OR: 3.84, 95% CI: 1.41-10.42, p=0.08) were higher after adjusting for confounders in multivariable analysis (figure 1). Conclusion: This study demonstrates that the LAAO procedure had similar short-term outcomes between high and low-risk patients in a study of real-world patients.
Abstract 9359: Orai1 Inhibitors as Potential Treatments for Pulmonary Arterial Hypertension
Authors: Bastien Masson, Helene Le Ribeuz, Jessica Sabourin, Loann Laubry, Emily Woodhouse, Richard Foster, Yann Ruchon, Mary Dutheil, angele boet, Maria-Rosa Ghigna, Hans Gooroochurn, Vincent Thomas de Montpreville, Olaf M Mercier, David J Beech, Jean-Pierre Benitah, marc bailey, Marc Humbert, David Montani, veronique capuano, Fabrice Antigny
Journal: Circulation (2022)

Rationale: Pulmonary arterial hypertension (PAH) is characterized by progressive distal pulmonary artery (PA) obstruction, leading to right ventricular hypertrophy and failure. Exacerbated intracellular calcium (Ca 2+ ) signaling contributes to abnormalities in PA smooth muscle cells (PASMCs), including aberrant proliferation, apoptosis resistance, exacerbated migration, and arterial contractility. Store-operated Ca 2+ entry (SOCE) is involved in Ca 2+ homeostasis in PASMCs, but its properties in PAH are unclear. Methods: Using a combination of Ca 2+ imaging, molecular biology, in vitro , ex vivo , and in vivo approaches, we investigated the roles of SOCE channel Orai1 in PA remodeling in PAH, and determined the consequences of pharmacological Orai1 inhibition in vivo using experimental models of pulmonary hypertension (PH). Results: Human PASMCs (hPASMCs) from patients with PAH (PAH-hPASMCs) showed upregulation of SOCE and Orai1 expression, in which ERK1/2, nuclear factor of activated T cells (NFAT), and nuclear factor-kappa B (NFκB) were contributing factors. Using siRNA and two Orai1 inhibitors, we found that Orai1 inhibition reduced SOCE, mitochondrial Ca 2+ entry, aberrant proliferation, apoptosis resistance, migration, and excessive calcineurin activity in PAH-hPASMCs. Orai1 inhibitors reduced agonist-evoked constriction in human PAs. In experimental rat models of PH evoked by chronic-hypoxia or monocrotaline or Sugen/hypoxia, administration of Orai1 inhibitors (BTP2, JPIII, or 5J4) protected against PH. Conclusions: In human PAH and experimental PH, Orai1 expression and activity are increased. Orai1 inhibition normalizes the PAH-hPASMC phenotype and attenuates PH in rat models, suggesting that Orai1 should be considered as a relevant therapeutic target for PAH.
Abstract 9439: Association of Renal Function With Abnormal Hemodynamics and Severity of Pulmonary Arterial Hypertension
Authors: Chih-Hung Lai
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular pressure and resistance that ultimately resulted in right heart failure and the deterioration of related hemodynamic parameters, precipitating the alternation of renal function and prognosis. However, which hemodynamic parameter associating the severity of PAH might alter renal function remains uncertain. Methods: The PAH cohort were extracted from the TAIPANS, a multicenter, prospective, observational registry of the clinical course and disease management of PAH patients. The COMPERA risk assessment strategy was used to grading the severity of PAH into low, intermediate, or high risk. The calculation of eGFR by using the MDRD formula. Results: A total 353 PAH diagnosed patients were included from TAIPANS registry. The higher risks group had been significantly older, higher WHO Fc, higher NT-pro BNP level, worse right hemodyanmic parameters (Table 1). The higher risk group carried lower eGFR. After adjustment, the intermediate and high risk groups were significantly decreased eGFR (p trend=0.01) (Table 2). The component of COMPERA risk factors, especially RAP level, showed significant negative correlation with eGFR (Figure A). Conclusions: The renal dysfunction is associated with PAH severity and associated with worse hemodynamic, especially elevated RAP.
Abstract 9784: All-Cause Mortality and Cardiovascular Events in Cancer Patients Undergoing Hematopoietic Stem Cell Transplantation (Kurume-CREO Study)
Authors: Nagisa Morikawa, Tatsuhiro Shibata, Shoichiro Nohara, Koudai Shibao, Yoshihiro Fukumoto
Journal: Circulation (2022)

Backgrounds: Recent advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in cancer patients undergoing hematopoietic stem-cell transplantation (HSCT). However, there is limited evidence regarding prognosis, cardiovascular (CV) events and their predictors in patients undergoing HSCT. Therefore, we investigated the predictors for all-cause death and CV events in cancer patients undergoing HSCT. Methods: We enrolled 490 patients with hematological malignancies (n=399) and breast cancer (n= 91) in a prospective observational cohort study (Kurume-CREO study) in Kurume University from October 2016 to February 2021. Patients were followed up every 6 months after enrollment until August 2021. Outcomes were all-cause death, CV death and non-fatal CV events, the last defined as ≧ Grade 2 cardiac or vascular events based on CTCAE (Common Terminology Criteria for Adverse Events) v4.0-JCOG version. Results: The mean age ± standard deviation of all study subjects was 63.7 ± 13.4 years old. Among them, 107 all-cause deaths (21.8%), 84 CV events (17.1%, 3 CV deaths) were observed during the follow-up period (median:713.5 days). In this study, 60 patients (all were patients with hematological malignancies) received HSCT. The 3-year survival rate was 63.6% (Figure 1A) and the 3-year CV event-free rate was 70.7% (Figure 1B) in 60 patients with HSCT. Age- and sex-adjusted Cox proportional hazards analysis showed that hypoalbuminemia (p=0.02), anemia (p=0.03), low platelet count (p=0.0009) and history of depression (p=0.01) were associated with all-cause mortality and non-fatal CV events were associated with receiving a second HSCT (p=0.006). Conclusions: Nutritional status and anemia were associated with all-cause mortality and second HSCT was a risk factor for future CV events in patients undergoing HSCT. Thus, oncologists should carefully monitor cancer patients, particularly after second HSCT, and consult with cardiologists.
Abstract 9558: Twenty Five-Year Trends of Serum Cholesterol Levels and Incidence of Atrial Fibrillation: The Kuakini Honolulu Heart Program
Authors: Tagayasu Anzai, Andrewg Grandinetti, Alan Katz, Eric Hurwitz, Wu Yan Yan, Kamal Masaki
Journal: Circulation (2022)

Introduction: Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation (AF). However, the etiology is uncertain. One potential explanation might be the different trends in serum total cholesterol (TC) between AF and non-AF groups. Hypothesis: There are different 25-year trends in TC levels in older men with vs. without incident AF during the 25-year period. Methods: We used data from the Kuakini Honolulu Heart Program, a longitudinal cohort study since 1965. Participants were 3,741 Japanese-American men living in Hawaii who participated in the 4th exam cycle. TC level was repeatedly measured at baseline (mid-life, ages 45-68 years) and after 25 years (late-life, ages 71-93 years). The amount of TC reduction between mid- and late-life was categorized into quartiles. AF was diagnosed by 12-lead ECG at mid- and late-life. We excluded participants who were diagnosed with AF at mid-life (prevalent cases). Results: AF incidence was 4.4% over 25 years. Mid-life TC levels were similar between those with incident AF vs. those without (218.6±36.0mg/dl vs 218.6±35.4mg/dl, p=0.91). However, in those with incident AF, the drop in TC levels between mid- and late-life was significantly larger than in those without AF (-39.4±35.8mg/dl vs -27.9±38.0mg/dl, p&lt;0.001) (Fig1). Moreover, after multivariable adjustment, there was a biological gradient between AF incidence and reduction of TC levels over 25 years (P for tend p&lt;0.001). As a result, the group with incident AF showed significantly lower late-life TC levels compared with the non-AF group (179.7±32.9mg/dl vs 190.3±33.0mg/dl, p&lt;0.001) at late-life (Fig1). Conclusions: Incident AF over 25 years was associated with a greater decrease in serum TC levels between mid- and late-life. The paradoxical associations between AF prevalence and low TC levels might be explained by the different trends in drop from mid- to late-life TC between those with vs. without incident AF.
Abstract 310: Disparities Between Reported And Actual First Pass Discovered After Video Review Of Prehospital Intubations
Authors: TIMOTHY A BURNS, Henry Wang, Roger Stone, Ben Kaufman
Journal: Circulation (2022)

Purpose: Often emphasized as a best practice in prehospital airway management, first-pass intubation success (FPS) depends upon paramedic self-reports. We sought to determine the accuracy of paramedic reports of FPS in prehospital airway management. Methods: We analyzed adult (age &gt;=18 years) prehospital airway management data from a ground EMS agency, including cases from 5/1/2020 to 2/28/2022. Paramedics performed all adult prehospital endotracheal intubations (ETI) using standard video laryngoscopy (Airtraq, Mountain View CA) with a hyperangulated blade. Paramedics did not use neuromuscular blocking agents for ETI. Real time video images were recorded for all cases. We excluded cases where the video was missing, data was not captured, or the video was of insufficient quality. Each video was reviewed by a single independent rater using the same objective definition of FPS as the paramedic. The primary outcome was FPS, defined as correct intratracheal placement on the first video laryngoscopy. We evaluated agreement between paramedic and reviewer-reported FPS using Cohen’s Kappa statistic. Results: There were a total of 514 ETI cases, including cardiac arrest, trauma, and non-arrest medical. Paramedic and reviewer reported FPS agreed in 429/514 (83.5%) and disagreed in 85 (16.5%). Of the discordant cases, the paramedic reported FPS but the reviewer disagreed in 78 (92%). Interrater agreement was strong; kappa 0.659 (95%CI 0.595 - 0.722). FPS discordance was not associated with patient age, sex, cardiac arrest status. Conclusions: Despite the computed Kappa statistic showing strong interrater reliability, the objective nature of the rating leaves very little room for discordance. The expected result would have been near compete agreement, however 15% of cases resulted in disagreement. Additionally, when there was disagreement, it overwhelmingly favored the clinician reporting FPS when the reviewer disagreed. Paramedics incorrectly reported FPS in 1 of 6 ETI. Independent review is essential in the assessment of prehospital ETI performance. Further study is needed to determine the reasons for the discordance that may include confusion about the FPS definition or incentivization (real or perceived) of reporting outcomes in a particular way.
Abstract 9375: Role of Cardiac MRI in the Evaluation of T Wave Inversion in a Large Pre-Participation Cohort of Young Asian Males
Authors: Nishanth Thiagarajan
Journal: Circulation (2022)

Introduction: Abnormal T wave inversion (ATWI) in the pre-participation screening (PPS) electrocardiogram (ECG) may signify underlying myocardial disorders (e.g. cardiomyopathy, myocarditis) associated with sudden cardiac death. Current guidelines for competitive athletes recommend evaluation of ATWI with transthoracic echocardiography (TTE) and follow-on cardiac magnetic resonance imaging (CMR) if TTE is normal (i.e. echo-negative). However, data on evaluation of ATWI detected on PPS outside of competitive athletes (e.g. recreational athletes or military enlistees) is lacking. Methods: We studied the yield of ATWI evaluation in a large unselected cohort of 48115 young Asian male military enlistees who underwent PPS between 2019-2021. Individuals with ATWI meeting the International Criteria 2017 definition underwent TTE. Echo-negative individuals with persistent ATWI on repeat ECG further underwent CMR and were followed up for 12 ± 8 months. Routine demographic, anthropometric and ECG parameters were collected. Individuals with known heart disease or conduction abnormalities (e.g. RBBB) were excluded. Results: 133 (0.3%) individuals had ATWI, amongst whom TTE detected 3 (2.3%) individuals with cardiomyopathy. 105 echo-negative individuals had persistent ATWI and underwent CMR, which detected a further 5 (4.8%) cases of cardiomyopathy and 2 (1.9%) cases of prior myocarditis with residual scar. Echo-negative individuals with myocardial disorders on CMR had deeper ATWI of ≥ 2mm (p=0.047), ATWI in lateral (p=0.046) or all 3 territories (p=0.006), and concomitant ST segment depressions (p=0.030). ATWI depth of &lt; 2mm demonstrated 100% negative predictive value for myocardial disorders on TTE or CMR. Conclusions: Evaluation of ATWI in our unselected cohort of young Asian males identified myocardial disorders in 7.5%, with follow-on CMR increasing the diagnostic yield by 3-fold compared to TTE alone. Our findings confirm that CMR has utility in the evaluation of ATWI detected by PPS even in unselected individuals outside the competitive athletic setting. ATWI depth of ≥2mm was present in all individuals with myocardial disorders, and may serve as a cut-off value for further CMR evaluation in settings with resource limitations.
Abstract 308: Efficacy Of Distance Learning For Cardiopulmonary Resuscitation Training Utilizing Smartphone App And Mannikin Delivery-collection System
Authors: Stephen Gyung Won LEE, Ki Jeong Hong, Kyoung J Song, Wonpyo Hong, YongJoo Park, Ki Hong Kim, Hanna Yoon, Hyouk Jae Lim, Seul Ki Choi, Gyeongmin Lee, Kang bin Lee
Journal: Circulation (2022)

Aim of the study: Effective CPR training is important for provision of high-quality bystander cardiopulmonary resuscitation (CPR). However, the COVID-19 pandemic has hindered conventional face-to-face CPR training. To overcome the limitation, we developed a distance learning CPR training course (HEROS-Remote) that utilized a smartphone app and a delivery-collection system for CPR training manikins. The objective of the study was to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality between trainees who participated in the conventional CPR training (C-training) and HEROS-Remote course (R-training). Methods: The non-inferiority trial included adult nonhealthcare providers who applied for CPR training. Both groups underwent 2-minute post-training chest compression test followed by course survey on trainees’ course and delivery system satisfaction. The primary outcome of the study was mean chest compression depth during the 2-minute post-training test. Results: A total of 180 trainees were enrolled with 90 trainees for each training group. There was no statistically significant difference in chest compression depth between R-training and C-training groups (67.4 vs. 67.8, p=0.78) as well as proportion of adequate chest compression depth, chest compression rate, proportion of chest compressions with complete chest recoil and chest compression score (90.8 vs. 92.1, p=0.69; 110.8 vs. 110.4, p=0.60; 89.8 vs. 94.7, p=0.05; 92.7 vs. 95.5, p=0.16, respectively). In the R-training group, 90.0% of the trainees were satisfied with the course, 96% responded that the delivery system was satisfactory and convenient. Conclusion: The R-training course was noninferior to the C-training course. The distance learning CPR training method utilizing smartphone app and mannikin delivery-collection system had high user satisfaction and was logistically feasible.